| NPI | 1235540824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102204280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102204280) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2023-10-02 |